Task 2: Medicare: History of NHANES and CMS data

Administered by CMS, Medicare is the primary health insurance program for people ages 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (ESRD). Nearly all Medicare beneficiaries receive Part A hospital insurance benefits, which help cover inpatient hospital care, skilled nursing facility stays, home health and hospice care. Most beneficiaries also subscribe to Part B medical insurance benefits, which help to cover physician services, outpatient care, durable medical equipment and some home health care. Additionally, many beneficiaries elect to purchase Medicare Part D prescription drug coverage (available since 2006). Beneficiaries may elect to receive traditional fee-for-service (FFS) Medicare or, as an alternative, enroll in Medicare Part C plans. Medicare Part C plans are also referred to as Medicare Advantage (MA) and include Health Maintenance Organizations (HMOs), Managed Care Plans, Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. These are private plans similar to managed care organizations which provide Medicare Part A and Part B services, and for 2006 forward, also must provide Part D prescription drug coverage.

Where do the Medicare data come from?

The Medicare data are from CMS enrollment files and FFS administrative claims submitted for payment to CMS.  This information, beginning with 1999 data, has been linked with the continuous NHANES files. The range of years of Medicare data that are linked are described in Course 1, Module 3, Task 2 “NHANES-CMS Linked Data Years of Availability”.



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